For the Newly Depressed, One Drug Will Do

It can be tough to find the right antidepressant since any given drug works for — at most — about two-thirds of people who try it.

Well then, wouldn’t it make sense to take more than one drug at the same time, you might ask? Some research, including a major clinical trial called STAR*D, has suggested that strategy has merit. In that trial, thousands of patients were systematically given different medication regimens, including a combination of drugs, and the majority of patients found that their depression lifted.

But a new study published in the American Journal of Psychiatry suggests that newly depressed patients shouldn’t start out with two drugs: combination therapy appeared to be no more effective than a single drug in improving depression symptoms.

Some 665 moderately to severely depressed patients were given escitalopram (also known as Lexapro), escitalopram plus buproprion (Wellbutrin/Zyban) or venlafaxine (Effexor) plus mirtazapine (Remeron) and followed for seven months.

At both the three- and seven-month points, the combination treatment groups did about as well as the single-medicine group.

“The clinical implications are very clear — the extra cost and burden of two medications is not worthwhile as a first treatment step,” said Madhukar Trivedi, one of the authors of the paper and a professor of psychiatry at UT Southwestern Medical Center, in a press release.

Most depressed patients are only taking one antidepressant at a time, according to a 2007 study, but the trend of prescribing two or more at a time appears to be going up, according to a more recent study.

A patient should have only one consideration when agreeing to take potent antidepressant medication: In conjunction with other therapy when will I stop taking antidepressant medication. More often than not, the patient is prescribed an antidepressant because the insurance company wants to keep the doctor's visit to 6 minutes and antidepressant medication costs them hundreds of dollars per year and therapy costs thousands.

There are no long term studies of the effect of a life time of antidepressants.

Long term use of these potent medications have may have significant health consequences that no one has reported or researched.

I offer the following observatio­n. I have known identical twin sisters. Both shared a dysfunctio­nal childhood. One twin learned to cope with her sadness and loss. The other twin started medicating 15 years ago with gradually more potent antidepressants: zoloft, then prozac and she has been on 150 mg to 300 mg of effexor for the last 3 years.

Recently I observed these identical twins. The medicated twin In comparison to the non-medica­ted twin, “flickers” like someone with early Parkinson’­s disease, she unconsciou­sly rolls her tongue and forces it in and out of her rounded lips, unconsciou­sly circuitous­ly rubs the tip of her index fingers against the first joint of her thumbs and she has a comparativ­ely weakened memory.

The science of serotonin reuptake inhibitors effect on depression hypothesiz­ed by Nemeroff 20 years ago has yet to be proven.

Leading off the national news today was the latest report from the Army showing an alarmingly high rate of suicides. More deaths occurred from suicide and risky behavior than on the battlefield.

Previous reports have raised concern about the popularity of antidepressants in the military. The FDA has required warnings of suicide to be included in the labels of this class of drug. Meanwhile, the benefit of antidepressants has been raised into question as reports show that the negative drug trials were never published, thus skewing the body of literature. CurrentMedicine.TV described the details in a previous report.

December 1, 2009

Senator Benjamin Cardin (D-MD) discusses his recent investigation into the high usage rate of antidepressants in the military. In many cases, the medications are administered in unsupervised battlefields. Coinciding with this is the soaring rate of suicide in the military.